Ehlig David, Schöner Lukas, Geissler Alexander, Wittich Laura, Busse Reinhard, Vogel Justus
Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, 9000, St.Gallen, Switzerland.
Department of Health Care Management, Technical University of Berlin, Berlin, Germany.
Eur J Health Econ. 2025 Aug 7. doi: 10.1007/s10198-025-01810-6.
Healthcare systems increasingly face shortages of medical professionals, and simultaneously experience a rise in demand for healthcare services. In this study, we investigated whether a digital PROM-based monitoring and alert system for hip and knee replacement patients post-surgery can support in decreasing healthcare expenditures and utilization.
We used data from the randomized controlled trial PROMoting Quality, focusing on 546 hip and 492 knee replacement patients from nine German hospitals between October 2019 and December 2020 with available claims data. Patients were equally randomized into two groups: one receiving a PROM-based intervention at 1, 3, and 6 months post-surgery, the other receiving standard care. We compared 1-year post-surgery healthcare utilization using mixed-effects regression models. We further extrapolated the intervention effects to the German healthcare system.
Results showed post-surgery health expenditure reductions of 7.9% (-318.08, p = 0.015) for hip and 7.3% (-386.72, p = 0.053) for knee replacements. Significant decreases were observed in outpatient care contacts (-1.51, p = 0.005), physiotherapy sessions (-1.65, p = 0.037), and number of prescriptions (-2.14, p = 0.042) for hip replacements. For knee replacement patients, significant determinants of the cost differences were fewer prescriptions (-3.40, p = 0.013) and medical aids (-0.81, p = 0.041).
Our findings suggest that digital health interventions can reduce utilization and save scarce healthcare resources. It can be hypothesized that the "being taken care of" effect reduced the need for reassurance of the recovery progress, leading to fewer GP visits and decreased utilization of other healthcare services.
医疗系统日益面临医疗专业人员短缺的问题，同时医疗服务需求也在上升。在本研究中，我们调查了一种基于患者报告结局（PROM）的数字化监测与警报系统，用于髋膝关节置换术后患者，是否有助于降低医疗支出和医疗服务利用率。
我们使用了来自随机对照试验“促进质量”（PROMoting Quality）的数据，该试验聚焦于2019年10月至2020年12月期间来自德国九家医院的546名髋关节置换患者和492名膝关节置换患者，这些患者均有可用的索赔数据。患者被随机分为两组：一组在术后1个月、3个月和6个月接受基于PROM的干预，另一组接受标准护理。我们使用混合效应回归模型比较了术后1年的医疗服务利用率。我们还将干预效果外推至德国医疗系统。
结果显示，髋关节置换术后医疗支出减少了7.9%（-318.08，p = 0.015），膝关节置换术后减少了7.3%（-386.72，p = 0.053）。髋关节置换患者的门诊就诊次数（-1.51，p = 0.005）、物理治疗疗程（-1.65，p = 0.037）和处方数量（-2.14，p = 0.042）均显著减少。对于膝关节置换患者，成本差异的显著决定因素是处方数量减少（-3.40，p = 0.013）和医疗辅助器具减少（-0.81，p = 0.041）。
我们的研究结果表明，数字健康干预可以降低利用率并节省稀缺的医疗资源。可以推测，“得到照顾”的效果减少了对康复进展进行 reassurance 的需求，从而减少了全科医生就诊次数和其他医疗服务的利用率。
